Depressed stroke patients often not treated for depression

September 28, 2006

Despite a high rate of depression, few stroke survivors take antidepressants, according to a study in Stroke: Journal of the American Heart Association.

Studies have suggested an association between stroke survival and mood disturbances such as depression. But it's been unclear how many stroke survivors suffer from depression and how many are treated, particularly in the long term, said Seana L. Paul, B.Sc. (Hons), lead author of the study and researcher at the National Stroke Research Institute in Victoria, Australia.

"Stroke patients suffering from depression have been found to have reduced quality of life and a higher rate of death, so it is important to identify and treat depression after stroke," Paul said.

From May 1, 1997 to April 30, 1999, researchers identified those who had a stroke among 306,631 people in the North East Melbourne Stroke Incidence Study (NEMESIS). Researchers excluded those who had suffered a subarachnoid hemorrhage (bleeding in the brain).

Nurse researchers visited the 289 participants (51 percent men, average age 73) in their homes five years after their stroke. During the interviews, the researchers assessed participants for depression and asked about all medications they were taking, including antidepressants.

At five years after stroke, researchers found: "We have confirmed that depression is common even up to five years after stroke, and that the majority of those taking antidepressant medication were not depressed," Paul said. "This provides indirect evidence that antidepressants are effective in treating depression in stroke patients."

She said several factors contribute to the small percentage of depressed stroke patients taking antidepressant medication.

"The low treatment levels found in this study may indicate that physicians are unwilling to prescribe treatments that have not been demonstrated to be an effective and safe treatment for depression among stroke patients," Paul said. "Another factor may be that depression among stroke patients is not being diagnosed.

"We know that stroke survivors who are not depressed live longer, higher-quality lives than those who are depressed. Consequently, educating physicians, stroke survivors and their families about the risk of depression after stroke may increase identification of depression and lead to improved treatment."

The findings demonstrate the urgent need for a large randomized controlled trial of antidepressant medication after stroke, she said.

In previous studies, researchers have only used small samples of patients and have had inadequate follow up and limited ability to properly assess the efficacy of antidepressant medication in depression after stroke.
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Co-authors are: Helen M. Dewey, Ph.D.; Jonathan W. Sturm, Ph.D.; Richard A.L. Macdonell, M.D.; and Amanda G. Thrift, Ph.D.

The National Health and Medical Research Council, the Victorian Health Promotion Foundation, the Foundation for High Blood Pressure Research and the National Stroke Foundation funded the study.

Editor's Note: For general information about stroke, visit www.StrokeAssociation.org.

Statements and conclusions of study authors published in the American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect association policy or position. The American Heart Association makes no representation or warranty as to their accuracy or reliability.

American Heart Association

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